Why bring up SARS now? Because these days, public health officials are wringing their hands over two new viruses with pandemic potential: the H7N9 bird flu in China and a SARS-related coronavirus that has emerged in the Middle East, now being called MERS (Middle East Respiratory Syndrome).

Both viruses "remind us that the threat from emerging and epidemic-prone diseases is ever-present," Chan said in the Palais de Nations.

"Constant mutation and adaptation are the survival mechanisms of the microbial world," she said. "It will always deliver surprises."

But while Chan publicly thanked China for "collecting and communicating such a wealth of information" on H7N9, she made no mention of how Middle Eastern governments have responded to MERS. Thirteen months after the first known cases, the world still has very little information about this deadly virus, which has now killed 20 people and infected at least 31. Arecent outbreak in the eastern part of Saudi Arabia — the country where the majority of cases have been reported — has also infected 22 people and killed nine, and very little is known about these latest cases.

There are no specific events at the World Health Assembly dedicated to discussing the coronavirus (update: according to this Saudi Gazette report, Saudi Arabia has requested that coronavirus be discussed in Geneva this week) but on Monday morning, I sat down briefly with the pleasant and soft-spoken Dr. Tony Mounts, WHO's technical lead on the coronavirus, to talk MERS — what we know about it, what we don't know, and how worried we should be.

How concerned are you about the novel coronavirus?

So far, the mitigating feature is we haven't seen this spread beyond
health care facilities and close family, except for the two cases that were recently announced. So that’s reassuring — that it’s mostly a hospital-based outbreak among people that may have increased susceptibility.

There are a few things that have been happening recently that I think raise our level of concern. If this was just a hospital outbreak, that would not be so concerning. We’ve seen that before — we think the Jordan cluster back in April 2012 was probably a hospital outbreak that burned itself out and did not extend beyond the hospital.

But here you also have cases that are showing up in other countries; you have a case in France and local transmission in France. Again, it seems to have limited itself to the hospital setting but to see it spread to other countries like that is a real concern. There are a lot of workers from the Indian subcontinent and the Philippines working in the Middle East — people are also going back to some of these areas where there may not be the same facilities for picking up cases.

So my concern is that there may be travelers who are taking this back to Karachi or to Delhi or to Mumbai or Manila who are not being detected and you could have local transmission in those settings and it wouldn't be discovered until it's spread quite far.

What do we know so far about the possible source of this virus?

Still, we don’t know any more than we did in the beginning. The genetics of the virus make it look like a bat virus. But today, in spite of
quite a bit of work going on to try and find the sources, nobody's been able to
demonstrate the virus in an animal species. We think it must be an animal virus — it just doesn’t make sense that this would be a human virus circulating for a long period of time undetected. We just haven't been able to find the animal; there's no smoking gun.

We came back with some idea of what the government is doing — the
extent of the acitvities and intensity of the investigations that are going on. The (WHO) participants, when they returned, they were actually fairly reassured that
everything is being done that possibly could be done to investigate the causes of this outbreak and try and find the source. The (Saudi Arabian) ministry of health and the hospital where this
outbreak was based had instituted some measures that seem to be stopping the
transmission that was occurring in the hospital. So that was reassuring.

Can you describe some specific measures being taken in Saudi Arabia?

The results of their early
investigation indicates this is a nosocomial outbreak, meaning it's spread within the hospital environment. So they're doing the
kinds of things you’d normally do with a hospital outbreak: spacing the patients
a little more, doing isolation when somebody has respiratory symptoms, trying to be
more rigorous about all of the infection control practices ... they've instituted all of these things and as you know, they've invited people from the outside — a hospital infection control specialist from Canada — who's helping to advise them on the specifics of the interventions. It does seem to have stopped the transmission in the
hospital.

Why is there still so little known about this novel coronavirus?

I think the investigation is still going on and they’re
still trying to collect and collate all of the information. The story we got
from the (WHO) mission that returned is that the Saudis feel a little bit like
they’re drinking from a fire hose — it’s just a huge amount of information that they’ve
been collecting in a very short period of time and they just haven't had the time to
completely analyze and put it all together in summaries.

We have every expectation that they’re going to put
this (information) together and share it with the world.

Some have raised concerns about a lack of transparency around the sharing of information about the coronavirus. Do you share these concerns?

(Saudi Arabia) has shared
information about the cases when asked and they've notified us of new cases when they
occur. So they are fulfilling all of the obligations under the International Health Regulations but we do need this additional
information to really understand the threat that this virus poses. The biggest
question we need to know is what kind of exposures are happening that cause people to get infected; what are people doing, what are they coming into contact with, what are they eating or doing that
results in infection.

The Saudis are giving us information. We would like more of
it. Hopefully we’re working a bit more closely with them during the World Health Assembly and
helping them understand what we need. I think that they’re starting to wrap up
some of their early investigations; I’m hoping some of that information will
become available very soon.

There have been some reports following the recent outbreak in Saudi Arabia that the coronavirus has mutated — can you confirm that?

We haven’t seen the virus from this outbreak. There’s no genetic sequencing from this outbreak. I presume it’s being sequenced but it takes some time.

How similar is the current novel coronavirus situation to the early days of SARS?

There’s a limited amount of information about the
very beginning of SARS so we don’t really know what happened leading up to when it
became very public and very evident. There are some similiarities — the type of
illness it causes is similar, although of course the virus is in the same family. But we’re not seeing the kind of easy transmissions with this
virus that we saw in SARS.

Are there serological studies currently underway?

The Jordanians have just completed an investigation using
serology of their cases that happened a year ago. We’re expecting the results from that study in the next couple of weeks.

In that initial cluster, we only had two
confirmed cases — there were about a dozen people that had a similar illness but there were only clinical materials remaining to be
tested from two or three people. So what they have to do now is go back and draw blood from all of those people to see if the
illness that they had was actually this infection.

The coronavirus is not on the official agenda this week at the World Health Assembly. Do you expect it to come up?

A lot of what happens at formal meetings like this is a lot of the work actually gets done at informal sites — at coffee time and at lunch time. I know there are lots and lots of those kinds of
meetings going on and lots of discussions. So even if it isn't raised formally on
the floor of the plenary session, there are lots of discussions with the Saudis and other countries in the region. There’s already been some
discussions around the need to ramp up and increase the level of surveillance in other countries in the Middle East and try to get lab capacity up to speed in other countries so they can detect the virus. There’s no reason to expect that this virus is limited to
Saudi Arabia.

What would it take for you to start really getting worried about the coronavirus situation?

The biggest warning sign would be onward transmission. Right now the only places that we’ve seen human-to-human transmission is two settings; one is the hospital, and one is close family members. We've had several clusters like that ... local transmission where contact is very close, where there are factors that facilitate transmission of viruses between people — but we’ve not ever seen that extend beyond that, to transmit onward into the community. So the minute we see transmission occurring in a setting that doesn’t normally facilitate transmission, that would be a concern.

This interview has been edited and condensed.

Jennifer Yang is the Star’s global health reporter. She previously worked as a general assignment reporter and won a NNA in 2011 for her explanatory piece on the Chilean mining disaster. This week she is blogging from Geneva, where she is attending the World Health Assembly under a UN Foundation press fellowship. Follow her on Twitter: @jyangstar

05/15/2013

A worker tests condoms in a factory in the Chinese province of Guangzhou in 2005. (AP Photo)

Well it’s official: China’s world-famous fake manufacturers have boldly gone where no men have gone before – manufacturing fake condoms.

Chinese state media trumpeted the fact this week that police had busted a fake condom operation in the southern province of Fujian – back in March, actually.

Why authorities are making a big deal of it now isn’t clear.

Perhaps they’re hoping to sound alarm bells – and alarming it is: police started to investigate after finding condoms selling on taobao.com, China’s largest online marketplace, for just 1 Yuan, or about 16 cents.

The investigation led them to a workshop in the southern province of Fujian, where they arrested two owners and 10 workers, and confiscated 2 million fake condoms.

The workshop was pushing out 20,000 “condoms” per day, packaged under brand names like Durex, as well a popular Chinese brand known as Jissbon – a somewhat unfortunate translation of the name “James Bond.”

Two other workshops were also busted, one in the central Chinese province of Henan, and another in Zhejiang province, on the south east coast.

But the story is bigger.

Chinese entrepreneurs have also been exporting the product.

Media reports from Africa, where China has spent the better part of the last decade making itself an indispensable trading partner, show fake condoms from China have landed in Nigeria, Africa’s most populous nation, as well as in other countries.

Earlier this month, Nigeria’s National Agency for Food and Drug Administration announced the arrest of a trader in the capital of Lagos who had hauled in counterfeit drugs, medicines and fake Rough Rider condoms from China.

Olisameka Osefoh told police he had been working with a cartel in China.

He wasn’t the first: Osefoh’s arrest followed reports last month from the West African country of Ghana. FDA officials there warned the public to be on the look out for fake condoms from China marketed under the brand name “Be Safe.”

The state agency said batches of the condoms were inadequately lubricated, had visible holes and were prone to burst.

Bill Schiller has held bureau postings for the Star in Johannesburg, Berlin, London and Beijing. He is a NNA and Amnesty International Award winner, and a Harvard Nieman Fellow from the class of '06. Follow him on Twitter @wschiller

The report covers up to April 17, at which point there were 82 confirmed cases and two suspected cases, and it is chock-full of numbers and statistics. Here are some of the highlights:

63 is the median age of confirmed cases. 73 per cent are male. 86 per cent live in urban areas.

76 per cent of patients have underlying medical conditions

59 patients -- 77 per cent of the total -- were recently exposed to animals: 76 per cent to chickens, 20 per cent to ducks, seven per cent to swine. Two reported exposures to cats and one to a dog; six said they encountered wild birds and one was exposed to a pet bird.

Four patients worked as poultry workers, three slaughtered poultry at live markets and one transported poultry

Seventeen patients and one suspected case died of acute respiratory distress syndrome or multiorgan failure a median of 11 days after becoming sick.

Among 23 patients where detailed histories could be collected, the median incubation period for the virus was six days.

There have been three family clusters in two provinces, but only detailed information for two of them. In the first family, a man visited a live poultry market and observed the slaughter of a chicken which he purchased, cooked and ate two weeks before getting sick; in the second family, a man visited a live poultry market seven days before becoming ill.

Among 81 patients with available data, the median time from the onset of illness to the first medical visit was one day; the median time between getting sick and being hospitalized was 4.5 days.

As of April 17, investigators had detailed information on 678 close contacts of the confirmed patients. 62 per cent were health care workers, 20 per cent were relatives, 18 per cent were social contacts. Respiratory symptoms developed in 19 people who had contact with an H7N9 patient, including 15 health care workers and one medical intern; zero tested positive for H7N9.

The mortality rate for H7N9 is 21 per cent (although the rate will be lower if expanded surveillance efforts find more people who are asymptomatic cases).

Jennifer Yang is the Star’s global health reporter.
She previously worked as a general assignment reporter and won a NNA in
2011 for her explanatory piece on the Chilean mining disaster. Follow
her on Twitter: @jyangstar

04/23/2013

Children eat instant noodles in a
temporary settlement in Lingguan Middle School in Baoxing county of Yaan,
southwest China's Sichuan province. Clogged roads, debris and landslides impeded
rescuers on Monday as they battled to find survivors of a powerful earthquake
in mountainous southwest China that has left at least 192 dead. (AFP
PHOTOSTR/AFP/Getty Images)

H7N9 has now spread to six different provinces -- most cases are in the Shanghai area, but cases have also been confirmed in Beijing and Henan.

Source: European Centre for Disease Control and Prevention (updated as of April 15)

It can be difficult knowing how much to worry when something like this unfolds. But for now, this tweet from WHO spokesperson Gregory Hartl -- who has been actively answering H7N9 questions on Twitter -- seems to best summarize the current situation:

We are not near a #H7N9 pandemic yet but we need to understand better how the virus works in order to control the outbreak. @who

*Unlike other avian flu strains that have caused human infections, H7N9 doesn't seem to make birds sick. This means the virus can spread silently among birds and will be difficult to stamp out through culling -- and if the virus is getting picked up by wild birds, there's no telling how far H7N9 can travel. As Nature reports, H7N9 is "poised to spread."

*The virus has now been found in a four-year-old Beijing boy who has no symptoms, making him H7N9's first known asymptomatic case. The excellent Avian Flu Diary blog has a good explainer for why this is not necessarily good news.

Jennifer Yang is the Star’s global health reporter.
She previously worked as a general assignment reporter and won a NNA in
2011 for her explanatory piece on the Chilean mining disaster. Follow
her on Twitter: @jyangstar

04/15/2013

In 1979,
Shenzhen was a small fishing village with a
population of 20,000. Now it is rated 5th in the world in terms of population
density of over 10 million people. (RandyRisling/Toronto Star)

After years of growth, the surging Chinese economy has started to run out of steam.

For the first quarter of 2013, the Chinese economy grew only 7.7 per cent. Many analysts predicted a consistent 8 per cent growth rate for China -- a country which is edging out the United States as the world's biggest economy.

A slow-down in the manufacturing sector and overall global sluggishness is partly to blame for the slip.

The Financial Times reports that China's new premier, Li Keqiang, admits the future is unclear.

“Overall, the Chinese economy had a smooth start in 2013. But many uncertainties, both at home and abroad, still persist and make the overall situation quite complicated,” Keqiang said.

New York markets reacted to the downturn this morning as commodities fell to a nine-month low, followed by gold and silver tumbling.

According to Bloomberg, the Standard & Poor’s gauge of 24 raw materials dropped 1.4 per cent in New York after silver tumbled more than 11 per cent and gold traded below $1,400 an ounce.

"The international situation continues to concern people, both in regard to Europe and China," Boston-based fund manager John Carey told Bloomberg. "People are watching for some signs of improvement in both areas."

Tanya Talaga is the Star's global economics reporter. Follow her on Twitter @tanyatalaga

04/11/2013

A bear rescued from a bile farm, now living in a sanctuary in China. (Photo: Animals Asia)

A Chinese bear bile farm is putting off its stock market launch.

For now.

Guizhentang Pharmaceutical Company said the delay in their IPO is the result of needing more time to prepare the required information. It had been expected to file financial reports to the China Securities Regulatory Commission (CSRC) before May 13.

The company has encountered many difficulties since it first applied two years ago. Animals Asia, an agency that works in China, says these difficulties may reflect that neither the financial community nor the general public would support the listing of a company that extracts bile from live bears.

“Although we understand this is not a final withdrawal from the application process, it appears that Guizhentang has chosen to quietly withdraw from this confrontation between profit and animal welfare,” said Animals Asia.

The bear bile trade sees over 10,000 bears — mainly moon bears but also sun bears and brown bears — kept on farms in China, North Korea and Vietnam. The bears are "milked" regularly for their bile, which is used for traditional medicine.

According to reports, bile is usually extracted twice a day through an implanted tube; the process is believed to be painful as the bears moan and chew their paws while being "milked" for their bile.

Traditionally, bear bile was extracted by killing a wild animal and removing its gallbladder. But in the 1980s, bile farms began appearing in North Korea and eventually spread to other regions.

But there are other, less obvious ripple effects when a new virus suddenly pops up and causes widespread alarm. A few examples:

sales of isatis roots, used in herbal remedies, have "skyrocketed" in Fujian, China, according to China Daily

a sudden share boost for Malaysian rubber glove makers, according to Borneo Post

a feared shuttlecock shortage in "badminton-crazy Indonesia," which imports dried duck feathers from China for its shuttlecocks, according to this Agence France-Presse story

Jennifer Yang is the Star’s global health reporter.
She previously worked as a general assignment reporter and won a NNA in
2011 for her explanatory piece on the Chilean mining disaster. Follow
her on Twitter: @jyangstar

04/10/2013

The new bird flu strain continues to puzzle and alarm health officials in China and around the world. But thankfully, H7N9 isn't spreading easily between people -- yet.

Public health authorities are tightly crossing their fingers that the virus fails to mutate into a more dangerous form and will eventually just sputter out. The fear is that it will evolve into something more infectious -- like H1N1, which popped up in Mexico and caused a pandemic in 2009.

Luckily, H1N1 wound up being a pretty wimpy virus and caused mostly just mild disease -- but from the looks of it, an H7N9 pandemic would prove much more devastating.

You can bet public health officials worldwide are already preparing for that eventuality, which is why there is no better timing for this new paper, published in the Bulletin of the World Health Organization.

The paper comes from a group of scientists led by Dr. Kamran Khan, an infectious disease physician at St. Michael's Hospital and founder of BioDiaspora, a really interesting program that uses global flight patterns to predict the spread of new infectious diseases. (Khan spoke to the Toronto Star earlier this week about the likelihood of an H7N9-infected traveller from China coming to Canada -- for now, the chances of that are pretty low).

When outbreaks hit, public health officials have to make difficult but necessary decisions to prevent a virus from spreading further. They might consider airport screening, for instance -- but such measures should not be taken lightly, because they are hugely disruptive and require major resources.

So such actions need to have a strong scientific basis -- and that's where Khan's paper comes in. Looking at the 2009 H1N1 pandemic, Khan and his co-authors analyzed flight itineraries for more than 580,000 at-risk travellers who flew out of Mexico in May 2009.

They concluded it is much more efficient to screen passengers exiting an outbreak country than those arriving at their destination airports. According to Khan's estimates, all at-risk travellers during H1N1 could have been assessed with exit screening at Mexico's 36 international airports.

And 90 per cent of all at-risk travellers worldwide could have been captured by screening at just six of Mexico's largest international airports, coupled with targeted screening at two airports in Shanghai and Tokyo.

On the other hand, trying to screen those same travellers when they arrived at their destination airports would have required setting up checkpoints at 82 international airports in 26 countries.

And screening all international travellers at their arrival destinations would have been staggeringly difficult. During the H1N1 pandemic, this would have meant screening 67.3 million grumpy travellers at 1,111 airports -- and for every one person who actually had exposure to H1N1, 116 people would have been unnecessarily screened.

Using their findings, Khan and his co-authors developed a basic tool to help public health officials decide whether, and how, to set up airport screening. The tool takes three things into account: 1) whether there is effective exit screening at the source of the outbreak 2) whether a city receives direct flights from the outbreak country 3) the incubation period of the disease.

"One never waits for a fire to spread before putting it out," Khan said in a press release. For now, the H7N9 situation is just a few dozen sparks in eastern China -- let's hope it doesn't become a flame we have to snuff out.

Update: Canadian Press reporter Helen Branswell has written a great article about Khan's study, which has now been posted on the Toronto Star's website here.

Jennifer Yang is the Star’s global health reporter.
She previously worked as a general assignment reporter and won a NNA in
2011 for her explanatory piece on the Chilean mining disaster. Follow
her on Twitter: @jyangstar

04/09/2013

Chinese parents, desperate to access powdered milk that is not
tainted, appear to be the reason why supermarkets in the United Kingdom have
been asked to restrict sales of baby formula.

The Guardian is reporting Tuesday that there is evidence the
products are being bought in bulk for “unofficial export” to China.

Danone wants grocery stores to restrict sales to two 900g tins
per customer. Apparently, the formula has been flying off the shelves and being
sold online.

In a statement, Danone said they “understand that the increased
demand is being fuelled by unofficial exports to China to satisfy the needs of
parents who want Western brands for their babies.

“We would like to apologize to parents for any inconvenience
caused by this limit. We know that most parents only buy one pack at a time, so
we hope that the impact of this limit on U.K. parents will be minimal,” the
statement said.

Australia has also rationed powdered milk sales, the BBC
reports.

As previously reported in our World Daily blog, powdered milk sold
in Hong Kong stores has been in hot demand on the mainland since six children
died and nearly 300,000 sickened from melamine laced milk in 2008.

Chinese authorities have had to restrict how much formula can be
brought into the mainland and they’ve imposed stiff penalties of two years in
prison or up to $80,000 in fines if anyone is caught smuggling in more than is allowed.

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